Verrucae (Plantar Warts)

1. About the Diagnosis

Verrucae—commonly called plantar warts—are hyperkeratotic skin lesions on the soles of the feet caused by infection with human papillomavirus (HPV), most often types 1, 2, 4, or 63. The virus penetrates through small breaks in the skin, leading to localized epidermal proliferation.

2. Signs & Symptoms / Clinical Presentation

  • Appearance: Rough, cauliflower-like papules or plaques, often with black pinpoint dots (thrombosed capillaries).

  • Location & Distribution: Soles of the feet, especially weight-bearing areas (heel, metatarsal heads).

  • Pain: Tender when pinched laterally or under direct pressure (“walking on a pebble”).

  • Skin Lines: Disruption of normal dermatoglyphics (skin lines) over the lesion distinguishes verrucae from corns.

  • Duration: Lesions often persist for months to years without treatment but may spontaneously regress as immunity develops.

3. Diagnostic Tests

  1. Clinical Examination: Visual inspection and palpation are usually sufficient.

  2. Dermatoscopy: May reveal “red or black dots” (thrombosed capillaries) and interrupted skin lines.

  3. Biopsy: Rarely indicated—only when diagnosis is uncertain or a lesion is atypical (e.g., rapidly growing, ulcerated).

4. Treatment Plan

Approach* Description* Conservative*

Salicylic Acid Preparations: 17–40% gels, liquids, or plasters applied daily after soaking and debriding the lesion (e.g., Compound W®, Dr. Scholl’s® Clear Away).
• Duct-Tape Occlusion: Cover lesion with duct tape for 6 days, then soak, debride, and repeat.
• Protective Padding: Felt or foam heel cups to off-load pressure.

Procedural / Medical

• Cryotherapy: Liquid nitrogen spray or “freeze-and-thaw” applicators (e.g., Dr. Scholl’s® Freeze Away) every 2–3 weeks.
• Cantharidin (“Beetle Juice”): Topical application in office, blister forms and is debrided after 24–48 h.


• Topical Immunotherapy:
- Imiquimod 5% cream (Aldara®) applied nightly, stimulates local immune response.
- Intralesional Candida or mumps antigen injections to provoke wart clearance.
• Laser/Ablation: Pulsed-dye or CO₂ laser for refractory lesions.
• Bleomycin Injection: Intralesional bleomycin sulfate for resistant warts (painful; reserved for recalcitrant cases).

Products & Medications to Consider

Compound W® Salicylic Acid Pads/Gel

Dr. Scholl’s® Freeze Away Cryotherapy Kit

Cantharone™ (Cantharidin 0.7%)

Imiquimod 5% Cream (Aldara®)

Bleomycin Sulfate (intralesional; specialty practice)

Felt/ Foam Heel Cups (pressure off-loading)

Next Steps:
Begin with daily salicylic acid combined with protective off-loading for 6–8 weeks. If wart persists or is painful, escalate to in-office cryotherapy or cantharidin. For stubborn lesions, consider immunotherapy or referral for laser/ablative treatment.

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The content provided on this site is for educational purposes only and is not intended to replace the advice of a qualified medical professional. Always seek the guidance of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.*